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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by bertill33 on March 23, 2004, at 3:57:11
I am 25 have struggled with depression for 5 terrible years. I have been able to get out of major depression but even on meds that do not cause sexual problems I have no sex drive or function at all. It is getting extremly worrisome. I am hearing I should try mirapex or even deprenyl. Who has some good experience with dopamine based drugs. Wellbutrin did nothing for me. What is even worse is I have little motivation or emotional response. But the major depressive symptoms of pain, sadness and misery are treated.
Posted by King Vultan on March 23, 2004, at 8:00:55
In reply to Dopamine Agonists Mirapex, posted by bertill33 on March 23, 2004, at 3:57:11
> I am 25 have struggled with depression for 5 terrible years. I have been able to get out of major depression but even on meds that do not cause sexual problems I have no sex drive or function at all. It is getting extremly worrisome. I am hearing I should try mirapex or even deprenyl. Who has some good experience with dopamine based drugs. Wellbutrin did nothing for me. What is even worse is I have little motivation or emotional response. But the major depressive symptoms of pain, sadness and misery are treated.
I've had similar experiences on the drugs I've tried, including Wellbutrin, and have similar sexual issues. I was considering trying a dopamine agonist but thought I would try the MAO inhibitors first, as they are a more conservative approach IMO. I've read a great deal about dopamine agonists, and while they do work for some people, they also commonly cause nausea and/or somnolence. In fact, one of the major uses for the stimulant Provigil is to treat Parkinson's patients falling asleep in the middle of the day from their dopamine agonists.I decided to try the MAOI Nardil first, but the other one, Parnate, is considered to be a more pro-sexual drug. It is very dopaminergic and more powerful than Wellbutrin as an antidepressant, while also being quite activating, which I do not believe you would find a dopamine agonist to be. It has dietary restricitions which scare away many people, but these are rather overblown. Certain drug combinations must be avoided, however.
Todd
Posted by Ame Sans Vie on March 23, 2004, at 9:42:26
In reply to Dopamine Agonists Mirapex, posted by bertill33 on March 23, 2004, at 3:57:11
> I am 25 have struggled with depression for 5 terrible years. I have been able to get out of major depression but even on meds that do not cause sexual problems I have no sex drive or function at all. It is getting extremly worrisome. I am hearing I should try mirapex or even deprenyl. Who has some good experience with dopamine based drugs. Wellbutrin did nothing for me. What is even worse is I have little motivation or emotional response. But the major depressive symptoms of pain, sadness and misery are treated.
I have had (and continue to have) extremely positive experiences with several dopaminergic drugs. I've never used one to combat drug-induced sexual dysfunction simply because I either was not able to tolerate the meds that typically cause this side effect (i.e. Paxil, Zoloft, Luvox, Celexa, Lexapro, Anafranil, Elavil, Sinequan, Tofranil, Asendin, and Ludiomil [Prozac was fine for me, though]) or they didn't work (i.e. Nardil and Effexor). But I'm very familiar with these drugs' usefulness, or lack thereof, in treating akinesia and anhedonia.
You mentioned Mirapex -- my experience with it was wonderful at first. It definitely provided me with a ton of motivation and a great sense of purpose. But after a couple months or so, I began having the dreaded sleep attacks that King Vultan alluded to in his post. Maybe adding on Provigil or another CNS stimulant would have helped, but I guess I'll never know now -- my medication regimen at the moment is perfect. I took 1.5mg three times daily. You have to titrate your dose upward *very* slowly, unless you want to be lying on your bathroom floor with the most horrible, unrelenting nausea ever for six hours like I did several times when just beginning treatment. From what I understand Requip, which acts very similarly to Mirapex (i.e. it agonizes the same dopamine receptors), is not a whole lot different. And from what I hear, the same usually goes for Dostinex (cabergoline) and Parlodel (bromocriptine), but they aren't typically very useful for increasing motivation as they aren't as selective about which dopamine receptors they target.
Eldepryl (selegiline/deprenyl) *may* provide some benefit... theoretically. But I've never heard of it being used for sexual dysfunction. However, it definitely has the potential to increase motivation. Aside from increased dopamine levels, there may be a minor added bonus regarding one of selegiline's active metabolites -- levoamphetamine. While not nearly as potent as dextroamphetamine, it may provide *some* benefit. It's also metabolized to levomethamphetamine (aka levmetamfetamine, the stuff in Vick's Inhalers) and levodesmethylselegiline. You just need to keep the dose low -- some say don't go above 5mg, some say 10mg, some say 15mg... I think the general consensus is 5-10mg. At that dosage it's selective for inhibition of MAO-B and thus doesn't require the restrictions of a nonselective inhibitor of MAO; higher doses inhibit MAO-types A and B. Also, it's very important to note that if you're taking any antidepressant which increases serotonergic activity (even at MAO-B-selective doses), combination with selegiline may cause potentially fatal serotonin syndrome.
One important drug to consider is Symmetrel (amantadine). It is an antiviral and Parkinson's drug that actually causes *release* of dopamine. This has potential to be extremely helpful.
Sinemet (levodopa/carbidopa) may be worth considering if nothing else works.
The last of the truly dopaminergic drugs would be dextroamphetamine (Dexedrine/Dexedrine Spansules/DextroStat), dextroamphetamine sulfate/amphetamine sulfate/dextroamphetamine saccharate/amphetamine aspartate combo (Adderall/Adderall XR), methamphetamine (Desoxyn), methylphenidate (Ritalin/Ritalin SR/Ritalin LA/Methylin/Metadate SR/Metadate CD/Concerta), magnesium pemoline (Cylert/Cylert Chewable), benzphetamine (Didrex), phendimetrazine (Bontril/Bontril SR), phentermine (Adipex-P/Fastin/Ionamin), and diethylpropion (Tenuate/Tenuate Dospan). These all act on norepinephrine as well (well, maybe not pemoline... I'm still not sure if anyone knows exactly how it works). Also, the amphetamines has a small effect on serotonin and methamphetamine has a larger serotonergic effect. As far as I know, methylphenidate doesn't affect serotonin (at least directly). Quite a few people find these helpful with sexual dysfunction, and many, MANY people find them (especially amphetamine/methamphetamine) extremely motivating and energizing. Of course, your doctor would probably save these as a last resort, considering the high abuse potential of most of them. I currently take 60mg Adderall XR each morning and 7.5mg Desoxyn four times daily. I've also tried dextroamphetamine (DextroStat -- 15mg three times daily and Dexedrine Spansules -- 30mg each morning) as well as methylphenidate (in the form of Ritalin -- 20mg four times daily), but found it incredibly dull, personally. Pemoline is one I haven't tried, primarily because it can cause very serious liver problems, and also because I hear very few reports of success with this drug. It is only categorized under Schedule IV of the CSA though (same as the benzodiazepines, some mixed agonist/antagonist narcotics, long-acting barbiturates, various sedative/hypnotics, phentermine, and diethylpropion), so some doctors may prescribe it more readily -- you just have to have occasional blood work done to test your hepatic function. The rest of the drugs are diet drugs and for some odd reason many psychiatrists won't consider them, but they can be very effective stimulants and are all (according to the DEA, anyway) less likely to be abused than amphetamines or methylphenidate. Benzphetamine and phendimetrazine are Schedule III (along with some barbiturates, narcotic/non-narcotic combination drugs, dronabinol, and random other things); phentermine and diethylpropion are Schedule IV.
BuSpar has been purported to be helpful to some with sexual dysfunction caused by medication, but I haven't heard much from others about its use in this situation. It has a mild dopaminergic effect, but primarily affects serotonin by antagonizing 5-HT1a receptors.
Bethanechol (Urecholine) has also helped some people, though I think it's mainly used when the sexual dysfunction is MAOI-induced.
Cyproheptadine (Periactin) is an antihistamine that temporarily decreases the activity of serotonin -- many people find this helpful to take as-needed before sexual activity when taking serotonin-enhancing drugs. It does carry with it the possibility of temporarily bringing back your original symptoms since it in essence reverses the effect of the antidepressant. Oh, and it can be sedating -- sex is no fun when you're asleep. :-)
Yohimbine is an alpha-1 (and perhaps alpha-2 as well) adrenoreceptor agonist. It used to be prescribed often for impotence. It has a mild stimulant/euphoriant effect as well. You can get yohimbine by prescription, or you can buy standardized yohimbe extract capsules or liquid in health-food stores, GNC, etc. 5.4mg of yohimbine is often an effective dose. Consult your doctor before going out and trying it on your own though.
The last thing I can think of at the moment is gingko biloba. I've heard tell of it being used for this, but I haven't heard firsthand experiences. It's also available at most places you can buy supplements.
Hope this helped some (and sorry for being so long-winded! lol).
~~Michael
Posted by Questionmark on March 23, 2004, at 15:46:59
In reply to Re: Dopamine Agonists Mirapex » bertill33, posted by Ame Sans Vie on March 23, 2004, at 9:42:26
...cause such fatigue and drowsiness? Why are they different than the psychostimulants in that regard, besides only affect DA and not NE (unless that is the reason, but i would not think it would be). What are the pharmacological &/or physiological reasons for their drowsiness effects? Zanyone know?
And especially, how long do these side effects last. i was thinking they were only present for awhile during the start of treatment and then gradually faded, but according to Ame Sans Vie (Michael?), the opposite is true. That's disappointing.
Posted by jerrympls on March 23, 2004, at 19:45:21
In reply to Re: Dopamine Agonists Mirapex » bertill33, posted by Ame Sans Vie on March 23, 2004, at 9:42:26
>
> You mentioned Mirapex -- my experience with it was wonderful at first. It definitely provided me with a ton of motivation and a great sense of purpose. But after a couple months or so, I began having the dreaded sleep attacks that King Vultan alluded to in his post. Maybe adding on Provigil or another CNS stimulant would have helped, but I guess I'll never know now -- my medication regimen at the moment is perfect. I took 1.5mg three times daily. You have to titrate your dose upward *very* slowly, unless you want to be lying on your bathroom floor with the most horrible, unrelenting nausea ever for six hours like I did several times when just beginning treatment. From what I understand Requip, which acts very similarly to Mirapex (i.e. it agonizes the same dopamine receptors), is not a whole lot different. And from what I hear, the same usually goes for Dostinex (cabergoline) and Parlodel (bromocriptine), but they aren't typically very useful for increasing motivation as they aren't as selective about which dopamine receptors they target.
>>
> One important drug to consider is Symmetrel (amantadine). It is an antiviral and Parkinson's drug that actually causes *release* of dopamine. This has potential to be extremely helpful.
>Michael-
I've been wanting to get in touch with you regarding your experiences with Mirapex. I seemy pdoc this Friday and Mirapex or Amantadine may be a choice. I'm currently on 375mg of Effexor, 40mg Valium, 300 Seroquel (for sleep!) and 56mg of Concerta. I've heard so many positive things about Mirapex for depression - especially for those with severe apathy, lethargy, etc. But then I read in your posts that after a couple months or so you started to fall asleep in the middle of the day - why? What is it about Mirapex - or dopamine agonists - that would cause this? How ould you compare Amantadine to Mirapex? I've heard the side effects of Mirapex are not the greatest.
I'd be SOOOOO pleased if you responded here or emailed me (jerrympls@mn.rr.com).
Thanks so much!!!
Jerry
Posted by Keith Talent on March 23, 2004, at 23:34:58
In reply to Re: Dopamine Agonists Mirapex » Ame Sans Vie, posted by jerrympls on March 23, 2004, at 19:45:21
I would have thought that the problem with such a specifically-acting drug like Mirapex would be tolerance. Has anyone successfully used this day in, day out for months or years?
Posted by Stan on March 24, 2004, at 1:03:03
In reply to Re: Dopamine Agonists Mirapex, posted by Keith Talent on March 23, 2004, at 23:34:58
> I would have thought that the problem with such a specifically-acting drug like Mirapex would be tolerance. Has anyone successfully used this day in, day out for months or years?
>--------------------------------------------
i've been taking mirapex or requip for a couple of years to combat 'restless legs syndrome.' over this period i've gradually had to quadruple the dose i started with in order to maintain the same benefits. when i take mirapex i use .5 mg four times daily for a total of 2.0 per day, while requip requires 1.0 mg four times daily for a total of 4.0. i rotate them every six months or so, switching from mirapex to requip and vice versa in an attempt to gain a fresh response. the side effects (for me: upset stomach but no nausea, drowsiness, fatigue, lethargy) have never subsided.....parkinson's patients take higher dosages.....i don't know how they do it without passing out.
to the poster who asked about amantadine...hmmm....if i've got the name right, and i'm speaking strictly from memory, this is an antiviral drug primarily used to fight off influenza. i wasn't aware that it had any positive impact on mood disorders, but i don't keep up with medical research.
stan
Posted by rod on March 24, 2004, at 5:19:20
In reply to Re: Dopamine Agonists Mirapex » bertill33, posted by Ame Sans Vie on March 23, 2004, at 9:42:26
I think amantadine is pretty useless for mood disorders. My doctor has a double blind placebo controlled study of Amantadine for depression which showed its not better than placebo (I didnt found this one at pubmed). But I am sure, its somewhat working for a small subgroup of people. It increases synthesis of dopamine (via NMDA blockade) but also reduces Serotonin synthesis (also via NMDA blockade), inhibits reuptake and increases release of dopamine. All 1-aminoadamantanes (Memantine, Amantadine etc.) noncompetitively inhibit MAO activity (I think A+B, this wasnt specified in the abstract).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6891223
And actually I am taking Amantadine, but did *not* notice any positive effect on mood. At the beginning it gave me some nice freshness to my forebrain, but this subsided after a few days. And turned out to be somewhat a downer to me, like a mood stabiliser. I am currently tapering down, and notice that I am actually feeling better now.
But you wont know, until you try it. I did take it because I have antibodies for Borna Disease Virus in me.Roland
Posted by SLS on March 24, 2004, at 8:17:22
In reply to Re: Dopamine Agonists Amantadine, posted by rod on March 24, 2004, at 5:19:20
> And actually I am taking Amantadine, but did *not* notice any positive effect on mood. At the beginning it gave me some nice freshness to my forebrain, but this subsided after a few days. And turned out to be somewhat a downer to me, like a mood stabiliser. I am currently tapering down, and notice that I am actually feeling better now.
My experience with amantadine was similar to yours.
- Scott
Posted by CraigD on March 24, 2004, at 20:00:23
In reply to Re: Dopamine Agonists Amantadine, posted by SLS on March 24, 2004, at 8:17:22
I too am taking amantadine as a hopeful sexual antidote for my Celexa. I started by adding WB to appease my doctor, and it served as a nice adjunct to Celexa cognitively, but I don't think it did a whole lot sexually. When I first tried amantadine, I noticed it made me zoney, slow, dopey, etc., and somewhat anxious. I don't think I would want to take it on a daily basis as suggested due to these effects. So I basically take it if I'm out on the prowl. It helps me a little in terms of sexual interest/aggressiveness, but it also intensifies any liquor I've been drinking.
Unfortunately, the last time I was on Celexa, I discovered the only thing to really bring my sex drive back was a dopamine monsoon from cocaine or crystal meth. I'd love to find a happy medium. I tried to suggest a psychostim to my pdoc, but he said "no way not with your street drug history."
I tried to explain to him that only did the street drugs to bring back my sex drive, not because I love stimulants so much.
Oh well.
Posted by jerrympls on March 24, 2004, at 22:16:48
In reply to Re: Dopamine Agonists Amantadine, posted by CraigD on March 24, 2004, at 20:00:23
My pdoc suggested I try Abilify because - although it's an antipsychotic - it's a dopamine agonist & antagonist. she explained that it "finds" the places in your brain that need more dopamine and reduces it in parts that have too much dopamine.
Anyone????
Posted by Questionmark on March 25, 2004, at 1:33:30
In reply to Re: Dopamine Agonists : Abilify?, posted by jerrympls on March 24, 2004, at 22:16:48
> My pdoc suggested I try Abilify because - although it's an antipsychotic - it's a dopamine agonist & antagonist. she explained that it "finds" the places in your brain that need more dopamine and reduces it in parts that have too much dopamine.
>
> Anyone????That sounds excellent. But more realistically, it sounds incredibly naive. Freaking ignorant doctors. Why are there so many?
Wait, really?! It "'finds' the places in your brain that need more dopamine and reduces it in parts that have too much"?? That's AWEsome! That's just like how depression is caused by a lack of serotonin in the brain and why SSRIs cure that chemical imbalance! Wow! i gotta get me some Abilify!!What did the drug rep. tell her this? Oh, well no wonder she believed it.
(Sorry, mocking your doctor and many like her, not you).
Posted by Stan on March 25, 2004, at 2:21:00
In reply to Re: Dopamine Agonists : Abilify?, posted by jerrympls on March 24, 2004, at 22:16:48
> My pdoc suggested I try Abilify because - although it's an antipsychotic - it's a dopamine agonist & antagonist. she explained that it "finds" the places in your brain that need more dopamine and reduces it in parts that have too much dopamine.
>
> Anyone????-----------------------------------------
you might give that a try in place of the seroquel you're taking (probably wouldn't make sense to use both). sounds like a decent idea -- abilify is some sort of mixed agonist/antagonist that theoretically behaves roughly in the way your doc described. haven't tried it myself....what happened with the fentanyl (sp?) patch you were wearing? have you dropped that? just curious......
stan
Posted by jerrympls on March 25, 2004, at 18:20:34
In reply to Re: Dopamine Agonists : Abilify? » jerrympls, posted by Stan on March 25, 2004, at 2:21:00
> > My pdoc suggested I try Abilify because - although it's an antipsychotic - it's a dopamine agonist & antagonist. she explained that it "finds" the places in your brain that need more dopamine and reduces it in parts that have too much dopamine.
> >
> > Anyone????
>
> -----------------------------------------
> you might give that a try in place of the seroquel you're taking (probably wouldn't make sense to use both). sounds like a decent idea -- abilify is some sort of mixed agonist/antagonist that theoretically behaves roughly in the way your doc described. haven't tried it myself....
>
> what happened with the fentanyl (sp?) patch you were wearing? have you dropped that? just curious......
>
> stanHey Stan-
reagarding the Fentenyl (Druagesic Patch) = NOTHING. It made me a bit loopy at first thenhelped a *little* with anxiety. But that's it. I've tried to go off of it by myself twice and within 6 hours I start to go through some sort of horrific withdrawl - nothing I've ever experienced - terrible anxiety - sweating - nausea - bowel cramps - can't sit still - etc - so I've had to put the patch back on and within a couple hours I'm back to "normal." So now I'm pissed because I have to deal with withdrawl from a med that has had no effect on my mood - andm y sicktime at work is almost all used up. I've never abused any drug or done any street drugs - so I've never experienced withdrawl (expect for SSRI withdrawl which is horrible in it's own way). I see my pdoc tomorrow and am gonna have to convince her to give me something to help me ease through the withdrawl. UGH!!!!!
Posted by Damien on March 26, 2004, at 1:32:39
In reply to Re: Dopamine Agonists : Abilify? » Stan, posted by jerrympls on March 25, 2004, at 18:20:34
First, if you're using Duragesic for something other than severe pain, that's a big mistake. The synthetic opiate fentanyl is thousands of times more potent that morphine, and for a long time was not found outside of hospitals. Just about any anesthiseologist that winds up addicted to a drug,winds up addicted to fentanyl because of its availability and potency. You've probably noticed that the Duragesic potency is measured in MICROgrams rather than milligrams. (A microgram is one/thousandth of a milligram, for readers unfamiliar with that aspect of the metric system.) Anyway, it's no wonder you're experiencing withdrawals. You need medically-supervised dose tapering, perhaps involving another opiate to substitute for the fentanyl. I'm surprised, really that it was administered for something other than pain. After all, there really isn't anything stronger (legally, in the US).<br><p>
As to Abilify, it IS a dopamine agonist/antagonist and DOES have the unique property of agonizing and antagonizing in the areas of the brain where a deficit or surplus of dopamine occurs. Despite the derision that was heaped on the original poster, check out www.abilify.com if you want to see it all diagrammed out for you.Take care. Good luck with the fentanyl withdrawal process.
> > > My pdoc suggested I try Abilify because - although it's an antipsychotic - it's a dopamine agonist & antagonist. she explained that it "finds" the places in your brain that need more dopamine and reduces it in parts that have too much dopamine.
> > >
> > > Anyone????
> >
> > -----------------------------------------
> > you might give that a try in place of the seroquel you're taking (probably wouldn't make sense to use both). sounds like a decent idea -- abilify is some sort of mixed agonist/antagonist that theoretically behaves roughly in the way your doc described. haven't tried it myself....
> >
> > what happened with the fentanyl (sp?) patch you were wearing? have you dropped that? just curious......
> >
> > stan
>
> Hey Stan-
>
> reagarding the Fentenyl (Druagesic Patch) = NOTHING. It made me a bit loopy at first thenhelped a *little* with anxiety. But that's it. I've tried to go off of it by myself twice and within 6 hours I start to go through some sort of horrific withdrawl - nothing I've ever experienced - terrible anxiety - sweating - nausea - bowel cramps - can't sit still - etc - so I've had to put the patch back on and within a couple hours I'm back to "normal." So now I'm pissed because I have to deal with withdrawl from a med that has had no effect on my mood - andm y sicktime at work is almost all used up. I've never abused any drug or done any street drugs - so I've never experienced withdrawl (expect for SSRI withdrawl which is horrible in it's own way). I see my pdoc tomorrow and am gonna have to convince her to give me something to help me ease through the withdrawl. UGH!!!!!
>
>
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